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Ureteral injury after laparoscopic versus open colectomy.

Zafar SN, Ahaghotu CA, Libuit L, Ortega G, Coleman PW, Cornwell EE, Tran DD, Fullum TM - JSLS (2014 Jul-Sep)

Bottom Line: The crude incidence in the open group was higher than that in the laparoscopic group (0.66% versus 0.53%, P=.016).CEM produced 14 630 matching pairs.Laparoscopic colectomy is associated with a lower incidence of intraoperative ureteral injury when compared with open procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Howard University Hospital, Washington, DC, USA.

ABSTRACT

Background and objectives: Ureteral injury is an infrequent but potentially lethal complication of colectomy. We aimed to determine the incidence of intraoperative ureteral injury after laparoscopic and open colectomy and to determine the independent morbidity and mortality rates associated with ureteral injury.

Methods: We analyzed data from the National Surgical Quality Improvement Program for the years 2005-2010. All patients undergoing colectomy for benign, neoplastic, or inflammatory conditions were selected. Patients undergoing laparoscopic colectomy versus open colectomy were matched on disease severity and clinical and demographic characteristics. Multivariate logistic regression analyses and coarsened exact matching were used to determine the independent difference in the incidence of ureteral injury between the 2 groups. Multivariate models were also used to determine the independent association between postoperative complications associated with ureteral injury.

Results: Of a total of 94,526 colectomies, 33,092 (35%) were completed laparoscopically. Ureteral injury occurred in a total of 585 patients (0.6%). The crude incidence in the open group was higher than that in the laparoscopic group (0.66% versus 0.53%, P=.016). CEM produced 14 630 matching pairs. Matched analysis showed the likelihood of ureteral injury after laparoscopic colectomy to be 30% less than after open colectomy (odds ratio, 0.70; 95% confidence interval, 0.51-0.96). Patients with ureteral injury were independently more likely to have septic complications and have longer lengths of hospital stay than those without ureteral injury.

Conclusion: Laparoscopic colectomy is associated with a lower incidence of intraoperative ureteral injury when compared with open procedures. Ureteral injury leads to significant postoperative morbidity even if identified and repaired during the colectomy.

No MeSH data available.


Related in: MedlinePlus

Odds ratios and 95% confidence intervals of ureteral injury after laparoscopic versus open colectomy. (Reference is open colectomy.)
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Figure 1: Odds ratios and 95% confidence intervals of ureteral injury after laparoscopic versus open colectomy. (Reference is open colectomy.)

Mentions: Multivariate logistic regression analysis showed LC to be 39% less likely to be associated with UIs (OR, 0.6; 95% confidence interval [CI], 0.49–0.75). CEM produced 14 630 matching pairs. After matching, the imbalance between the 2 groups measured by the L1 distance was 0.02. The L1 distance provides for a global multivariable measure of imbalance between 2 groups. It ranges from 0 to 1, where 0 equals perfect global balance. Even after matching, the incidence of UI was higher in the OC group than in the LC group (0.71% versus 0.50%, P = .027). Conditional logistic regression showed the likelihood of having a UI to be 30% less for LC versus OC (OR, 0.70; 95% CI, 0.51–0.96) (Figure 1). Sensitivity analysis with conversions included in the LC group showed similar results (OR, 0.75; 95% CI, 0.56–0.99).


Ureteral injury after laparoscopic versus open colectomy.

Zafar SN, Ahaghotu CA, Libuit L, Ortega G, Coleman PW, Cornwell EE, Tran DD, Fullum TM - JSLS (2014 Jul-Sep)

Odds ratios and 95% confidence intervals of ureteral injury after laparoscopic versus open colectomy. (Reference is open colectomy.)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4208902&req=5

Figure 1: Odds ratios and 95% confidence intervals of ureteral injury after laparoscopic versus open colectomy. (Reference is open colectomy.)
Mentions: Multivariate logistic regression analysis showed LC to be 39% less likely to be associated with UIs (OR, 0.6; 95% confidence interval [CI], 0.49–0.75). CEM produced 14 630 matching pairs. After matching, the imbalance between the 2 groups measured by the L1 distance was 0.02. The L1 distance provides for a global multivariable measure of imbalance between 2 groups. It ranges from 0 to 1, where 0 equals perfect global balance. Even after matching, the incidence of UI was higher in the OC group than in the LC group (0.71% versus 0.50%, P = .027). Conditional logistic regression showed the likelihood of having a UI to be 30% less for LC versus OC (OR, 0.70; 95% CI, 0.51–0.96) (Figure 1). Sensitivity analysis with conversions included in the LC group showed similar results (OR, 0.75; 95% CI, 0.56–0.99).

Bottom Line: The crude incidence in the open group was higher than that in the laparoscopic group (0.66% versus 0.53%, P=.016).CEM produced 14 630 matching pairs.Laparoscopic colectomy is associated with a lower incidence of intraoperative ureteral injury when compared with open procedures.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Howard University Hospital, Washington, DC, USA.

ABSTRACT

Background and objectives: Ureteral injury is an infrequent but potentially lethal complication of colectomy. We aimed to determine the incidence of intraoperative ureteral injury after laparoscopic and open colectomy and to determine the independent morbidity and mortality rates associated with ureteral injury.

Methods: We analyzed data from the National Surgical Quality Improvement Program for the years 2005-2010. All patients undergoing colectomy for benign, neoplastic, or inflammatory conditions were selected. Patients undergoing laparoscopic colectomy versus open colectomy were matched on disease severity and clinical and demographic characteristics. Multivariate logistic regression analyses and coarsened exact matching were used to determine the independent difference in the incidence of ureteral injury between the 2 groups. Multivariate models were also used to determine the independent association between postoperative complications associated with ureteral injury.

Results: Of a total of 94,526 colectomies, 33,092 (35%) were completed laparoscopically. Ureteral injury occurred in a total of 585 patients (0.6%). The crude incidence in the open group was higher than that in the laparoscopic group (0.66% versus 0.53%, P=.016). CEM produced 14 630 matching pairs. Matched analysis showed the likelihood of ureteral injury after laparoscopic colectomy to be 30% less than after open colectomy (odds ratio, 0.70; 95% confidence interval, 0.51-0.96). Patients with ureteral injury were independently more likely to have septic complications and have longer lengths of hospital stay than those without ureteral injury.

Conclusion: Laparoscopic colectomy is associated with a lower incidence of intraoperative ureteral injury when compared with open procedures. Ureteral injury leads to significant postoperative morbidity even if identified and repaired during the colectomy.

No MeSH data available.


Related in: MedlinePlus